靶向B细胞治疗系统性红斑狼疮研究进展

系统性红斑狼疮(Systemic lupus erythematosus, SLE)是一种慢性、全身多系统受累的自身免疫性疾病。其病因和发病机制尚未完全明确,有研究表明B细胞过度增殖、活化是SLE发病至关重要的环节,也是造成全身多脏器损害的病理基础。因此B细胞成为SLE治疗的新型靶点,本综述主要围绕B细胞相关靶向治疗进展进行讨论,包括靶向B细胞表面抗原、靶向B细胞因子、共刺激阻断、酪氨酸蛋白激酶抑制剂等方面,重点介绍其已经结束或正在进行的临床试验以及实际上市后的临床应用。     

紫癜性肾炎患儿肠道菌群变化及临床意义研究

背景目前国内外关于过敏性紫癜（HSP）患儿肠道菌群变化的研究数量有限,且尚未见关于紫癜性肾炎（HSPN）患儿疾病早期肠道菌群变化的相关报道。目的 探讨HSPN患儿肠道菌群的变化及其在疾病发生、发展中的作用。方法 于2019年7—9月选取郑州大学第一附属医院儿科收治的37例HSP初治患儿作为试验组,另外同时选取12例健康志愿儿童作为对照组;并对HSPN患儿随访6个月,根据有无肾损伤进一步分为无肾损伤试验亚组13例和肾损伤试验亚组24例。收集HSP患儿与健康儿童的一般资料及粪便标本,应用高通量测序技术对所有研究对象的肠道菌群进行测序及分析,采用Alpha多样性（Shannon指数、Chao1指数、ACE指数）分析探讨样本内的微生物群落的丰度和多样性,通过主坐标分析（PCoA）来探究不同组别间群落结构的差异,利用线性判别分析及影响因子（LEfSe）分析找到组间差异显著的物种。结果 Alpha多样性分析显示,三组研究对象Shannon指数、Chao1指数、ACE指数比较,差异均无统计学意义（P>0.05）。PCoA显示,三组研究对象肠道菌群群落结构均有差异（P<0.05）;Adon...     

Plasminogen activation in plasma of patients with systemic lupus erythematosus

Summary We measured ₂-plasmin inhibitor-plasmin complexes (PI-PC) in plasma of patients with systemic lupus erythematosus (SLE) to examine the plasminogen activation in SLE. The plasma PI-PC level in 23 patients with SLE was significantly higher than that in 18 normal subjects (P<0.001) and the SLE patients with nephrotic syndrome had higher plasma PI-PC levels than those without nephrotic syndrome (P<0.01). In addition, the plasma PI-PC level was significantly correlated with the level of plasma C3 breakdown products (iC3b/C3dg) in the patients with SLE (r=0.53, P<0.01). These results suggest that plasminogen is activated in plasma of patients with SLE and that the plasminogen activation may be associated with the activation of complement in SLE.     

细胞毒性T淋巴细胞相关抗原4融合蛋白抑制狼疮肾炎患者外周血单个核细胞B7分子表达及

目的探讨细胞毒性T淋巴细胞相关抗原4融合蛋白(CTLA-4Ig)对活动期狼疮肾炎(LN)患者外周血单个核细胞(PBMC)细胞表面B7-1(CD80)和B7-2(CD86)表达的影响及其对抗双链DNA(dsDNA)抗体和免疫球蛋白产生的影响。方法将18例活动期LN患者的抗凝血标本随机分为LN的CTLA-4Ig处理组(LN-T组9例)和普通培养组(LN-NC组9例)。另以14例正常人的抗凝血标本为对照,随机分为正常人的CTLA-4Ig处理组(NC-T组7例)和普通培养组(NC-NC组7例)。用密度梯度离心法分离PBMC。处理组加入CTLA-4Ig(10ng/L)、普通培养组加入等量普通培养基37℃孵育72h后,采用流式细胞仪技术检测PBMC细胞表面B7-1和B7-2分子的表达;ELISA法检测孵育液中抗dsDNA抗体、IgG及IgM水平。结果活动期LN患者CTLA-4Ig处理组与普通培养组比较,PB-MC表面B7-2分子表达明显下降(P<0.01);B7-1分子表达无显著变化(P>0.05);孵育液中抗dsD-NA抗体、IgG及IgM的生成均明显减少(P<0.01)。而正常人的两组间各指标差异均无统计学意义(P>0.05)。结论CTLA-4Ig可抑制活动期LN患者的PBMC表面B7-2分子的表达,并可减少其抗dsDNA抗体、IgG及IgM的分泌。     

Assessment of class-specific antibodies against denatured DNA in patients with systemic lupus erythematosus

In this retrospective study 103 serum samples from 16 females with systemic lupus erythematosus (SLE), obtained during a mean follow-up time of 2 years, were investigated for the presence of anti-denatured [single-stranded (ss)] DNA antibodies of the IgG, IgM, and IgA classes. The anti-ssDNA antibodies were determined by an enzyme-linked immunosorbent assay (ELISA), and the results were expressed in three ways: as units derived from a single serum dilution and as two parameters,E andA, calculated from the dose-response curve,E being an estimate of the effective amount of antibodies andA a function of the reaction constant between the antigen and the antibody. The simultaneous occurrence of anti-ssDNA antibodies of all three immunoglobulin classes was seen most often in the patients with the shortest duration of the disease. Clinically active disease was found to correlate with high reaction constants of the IgA anti-ssDNA antibodies. There was also an association between the IgA anti-ssDNA antibody levels and the presence of nephritis. Great fluctuations in the amounts of effective antibodies of the IgG class were seen in seven patients, in six of whom changes in the disease activity also were seen. Changes in the disease activity were unaccompanied by fluctuations in the IgG anti-ssDNA levels in four patients; two of these patients were positive for antibodies against extractable nuclear antigens. We conclude that it is of value to express the results of the anti-ssDNA ELISA as a function of the dose-response curve when monitoring patients with SLE and that immunoglobulin class-specific determinations of anti-ssDNA antibodies may provide information about the disease activity in many patients with SLE.     

Presence of immunoglobulin M antibodies around the glomerular capillaries and in the mesangium of normal and passive Heymann nephritis rats

Summary Diffuse distribution of small, faintly staining, beaded deposits of rat immunoglobulin M (IgM) around the glomerular capillary blood vessels, and a more intensely staining larger deposition in the mesangium, were observed on the kidney sections of normal rats. As glomerular-fixed nephritogenic antigens are known to be present on the epithelial aspect of the glomerular basement membrane (GBM), especially at the soles of foot processes and at the slit pores, it was assumed that the IgM antibodies were directed against these antigens. Investigation by immunofluorescent antibody double-staining techniques of rat kidney sections obtained from normal and rabbit anti-FX1A-injected rats stained for the nephritogenic antigen showed that a number of antigenic sites in the glomeruli and in the mesangium shared antibody hits by heterologous rabbit IgG and autologous rat IgM antibodies. Most sites in the glomeruli stained specifically for rat IgM or rabbit IgG, but preferentially for the latter. The intensely fluorescent mesangial deposits stained mainly for rat IgM, indicating that at these sites the antigenic material was virtually saturated, while areas at the entry to the mesangial space also stained for rabbit IgG, indicating that at these locations free nephritogenic epitopes were still available for reaction with the anti-FX1A antibody. Western blot analysis have shown that the rabbit anti-rat FX1A IgG and the rat anti-rat KF3 IgM antibodies are directed against the same renal tubular-derived antigen with a molecular weight of 70,000. These experimental findings collectively demonstrate that the heterologous IgG and autologous IgM antibodies are directed against the same nephritogenic antigen, which is found in the glomeruli, the mesangium and the proximal convoluted tubules. Thus, the IgM autoantibody has a possible physiological role but, in addition, there is evidence of active immunophagocytic events, manifested in a rapid and continuous entrapment and expulsion of macromolecules after their processing by the mesangial cells of normal and passive Heymann nephritis rats.     

Interleukin-10 (IL-10) secretion in systemic lupus erythematosus and rheumatoid arthritis: IL-10-dependent CD4+CD45RO+ T cell-B cell antibody synthesis

Interleukin-10 (IL-10) is a major immunoregulatory cytokine and has a multitude of immunomodulatory effects in the immune system. In this study, we have examined the secretion andin vitro function of IL-10 in B cell hyperactivity in antibody production in two common autoimmune diseases, systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). IL-10 was detectable in serum of all active SLE and serum and synovial fluid samples of all RA patients but in none of the normal controls. B cells and CD4+CD45RO+ memory T cells secreted highly enhanced levels of IL-10 in SLE and RA versus normals. Increased IgM and IgG production by B cells-CD4+CD45RO+ T cells in SLE and RA was IL-10 dependent, since neutralization of IL-10 cytokine by anti-IL-10 antibody drastically reduced Ig synthesis in these coculture experiments. B cell hyperactivity in autoantibody production in SLE and RA may be a function of IL-10-dependent CD4+CD45RO+ Th2 cell activation. Therefore, IL-10 may play an important role in highly disturbed immune system and B cell-T cell function in these immune disorders.     

The Regulation of FasL Expression—A Distinguishing Feature Between Monocytes and T Lymphocytes/NK Cells with Possible Implications for SLE

Monocytes and lymphocytes from patients with systemic lupus erythematosus (SLE) had a higher cell surface expression of FasL than the corresponding cells from healthy individuals. Inhibitors of metalloproteases upregulated the surface expression of FasL in peripheral blood lymphocytes (PBL), indicating that a metalloprotease is responsible for the cleavage of FasL. The level of sFasL in serum was slightly increased in the patient group compared to the controls. Therefore, the possible contribution of various mononuclear cell types to the release of FasL was analyzed. Isolated NK cells and T lymphocytes released FasL into the medium and the release was prevented by inhibitors of metalloproteases. In contrast, isolated monocytes did not release FasL. FasR expression was elevated in patients with inverted CD4/CD8 ratio, while FasL expression showed no relationship to CD4/CD8 ratio. The absence of FasL release by isolated cells and a high level of surface expression of FasL distinguish monocytes and T lymphocytes/NK cells.     

Glyceraldehyde 3-phosphate dehydrogenase is a novel autoantigen leading autoimmune responses to proliferating cell nuclear antigen multiprotein complexes in lupus patients

Using 2-dimensional electrophoresis and ion-pair chromatography, we have identified elements of proliferating cell nuclear antigen (PCNA) multiprotein complexes that are reactive to antibodies in sera from patients with systemic lupus erythematosus. Among the various elements of the complexes, a 37 kDa protein (PI 8.5) that specifically reacted with SLE sera, but not with sera from patients with other connective tissue diseases, was identified as glyceraldehyde 3-phosphate dehydrogenase (GAPDH). Immunoblot analysis showed that SLE sera reactive with the 37 kDa protein specifically reacted with GAPDH, as did anti-GAPDH mAbs. The purified autoantibodies to GAPDH from lupus serum showed both nuclear speckled and cytoplasmic staining patterns in immunofluorescence on Hep-2 cells. In addition, enzyme-linked immunosorbent assay (ELISA) revealed the presence of anti-GAPDH autoantibodies in 47% of lupus patients. Longitudinal analysis of the reactivity of lupus sera to PCNA complexes showed the autoimmune response to spread from GAPDH to other elements of PCNA complexes, and the presence of anti-GAPDH antibodies was significantly correlated with increased levels of serum PCNA. Taken together, these findings suggest that GAPDH interacting with PCNA in association with its cellular function is a novel autoantigen recognized by lupus sera, and that GAPDH thus plays an important role in the induction of autoimmune responses against the PCNA complex.